Meeting patient expectations for a seamlessly connected experience with drug therapy is a competitive necessity for today’s biopharmaceutical enterprise. In the battle to differentiate a drug from others in the same therapeutic class, it’s keeping that “incisive edge” around services delivery that counts.
Building your brand requires investments focused on key access capabilities: moving patients quickly to therapy; resolving affordability issues related to benefit eligibility, formulary status and co-pay contributions; harnessing clinical data for insights that help providers find the precise treatment to drive adherence and improve outcomes; and raising patients’ overall engagement through a tailored mix of automated technologies and “high touch” personalized contacts like nursing, case management and behavioral counseling.
The challenges of staying close to patients, and managing their journey through a complex network of providers and payers, is accentuated by a transition in the specialty drug marketplace. These biologically complex, often expensive medicines are beginning to resemble the primary/chronic care segment, where physicians are able to choose among a variety of therapies for the same illness. Competition can lead to a costly pitched battle among brands for share of voice. An example is in oral oncology drugs, where dozens of new entrants to the market are replacing physician-administered infusion medicines, whose margins are traditionally much higher.
As a result, price points now matter in the specialty drug business. The trend is upending the economics of the traditional “Hub” model that backs up the prescription with extended clinical and administrative patient support services. This, in turn, is ramping up pressure from manufacturers of all sizes for customized hub programs that can be designed and run at a lower cost.
Adapting to a larger and more diverse competitive set in specialty ranked as the top issue for attendees at a conference, Optimizing the Hub and SPP Model, held late September in San Diego under the sponsorship of Pharm Exec’s sister conferencing unit, CBI. Fifteen years after the Hub concept first emerged to bring more structure and certainty to the patient journey, many brand managers agree it’s time for a reset.
Mainlining to the middle
No one questions the importance of keeping patients connected through each phase of the journey. What needs to change is the ability to offer manufacturers more choice, through a mix of different services focused on medicines priced from $300 to $1,000, with smaller patient populations. “In a competitive field like ‘specialty lite,’ the pressure is high for brand managers to get the best return on a new product’s roll-out expenses, including patient support. That calls for a customized, brand-centric strategy adequate to fill that growing middle space between the most expensive specialty drugs and traditional retail pharmacy,” Myra Reinhardt, Vice President of Product Strategy for Triplefin, a leading patient services Hub provider, told the CBI conference participants.
Triplefin has taken claim to this growing space with a dedicated program it calls Hub-Lite®. Hub-Lite® is centered on a streamlined, cost-efficient brand-specific process of engagement, in contrast to the broad, laborious case management approach characteristic of the traditional Hub model.
Far from being a down market version of the latter, Hub-Lite® is actually a highly collaborative venture. It begins with an intensive RFP review covering the relationship between the brand, the company’s overall product portfolio, and the details of product launch and other aspects of commercialization. It concludes with strategic capability analytics that create a specific workflow addressing all the key touch points of patient and provider engagement around the brand.
“Triplefin’s focus is always on the end game,” says Reinhardt. “Where do you want to go with the product? What needs should be solved? It’s a tailored solutions model, one that differentiates Triplefin from other Hub services that rely on a more homogenous set of capabilities for the client.” Reinhardt also emphasizes how important partnering with the brand team and other stakeholders is at every stage of the Hub-Lite® program, from design to execution. “Our expertise is unique in that we are building partnerships, not packages,” she says.
Power in partnering
That philosophy extends to a brand’s key intermediaries, like providers and payers. “We believe the future of the Hub servicing space rests on working collaboratively with them as part of a ‘win-win’ solution with the patient at the center.”
Triplefin’s Hub-Lite® model centers on finding lower-cost, high-performing efficiencies. Using its proprietary suite of digital solutions, Rx365®, as a framework for benefits verification and realtime decisions on prior authorization, it streamlines and automates activities that once relied on manual documentation or guesswork. Rx365® includes an automated, portal-based application template; simultaneous processing of financial and insurance benefit data, including patient-matching eligibility and verification criteria; and multipurpose online reporting forms to replace the cumbersome paper trail. Mechanization of these functions has proven to be highly productive, according to Reinhardt. “It’s a proactive defense, because a simple miscalculation on a reimbursement code can derail even the best access strategy.”
However, Triplefin’s customer-first orientation means that no patient service program should be based entirely on a depersonalized IT model. Hub-Lite®, in contrast, has a flexible design orientation that seeks to coalesce digital and human intervention. Adds Reinhardt: “Every action we take is motivated by what works to position the brand for success with patients and providers. If automation won’t yield measurable value for the end-user, in terms of a desirable therapeutic outcome, we will apply empathetic human touch services like counseling and reminder contacts, or we apply them both. It’s all about how best to influence the patient and get them engaged throughout their journey to better health.” This is a clear value differential for the patient and the manufacturer.
Case history: A solution to a siloed approach
Examples of Hub-Lite® in action showcase this flexible, multi-tiered strategy of engagement—all structured to enhance a brand’s ROI. In one instance, Triplefin worked with a brand whose launch campaign was failing due to a confusing and siloed patient support program, evidenced by high script abandonment at the initiation of therapy and a low rate of adherence during therapy—a pattern that Triplefin quickly tagged to the lack of follow-on outreach to vulnerable patients.
A Hub-Lite® program consisting of three linked initiatives was put in place. First, financial barriers were addressed by leveraging data that identified patients who were eligible for manufacturer co-pay support, combining that with a free trial offer of the medicine as an incentive to sign up for the Hub. Second, IT systems management and automation were introduced to create a single point of contact for patients. Third, IT efficiencies were reinforced through a “high touch” care manager network, with staff assigned to help patients on fill reminders, side-effects monitoring, health literacy education and other personalized approaches to boost compliance to therapy.
The metric on results? After only nine months, this enhanced engagement program yielded an 84 percent increase in second Rx fills for enrolled patients as well as a 2.5 day average increase in patient days on therapy.
More lite, not less
Triplefin is investing heavily in Hub-Lite®, convinced that market trends will make this signature patient support strategy even more relevant to tomorrow’s brand demographic. The “tweener” price segment is set to dominate growth in the specialty space at least to the end of the decade, making the majority of products look more like those competitively challenged primary care medicines to treat chronic conditions. Cost-shifting to patients will also continue apace, reaching a point very soon where consumer out-ofpocket spending on specialty drugs will exceed the outlays of commercial benefit insurers. However, make no mistake, Hub-Lite® benefits pharma of all sizes, targeting cost savings and greater competencies for manufacturers, providing a unique alternative to an advanced Hub.
The bottom line? Delivering the access that manufacturers require to meet ambitious launch targets will demand more—not less—of the expertise in removing financial hurdles for patients imposed by payers while raising adherence and persistency rates that appeal to providers. And manufacturers will expect this expertise to be delivered more efficiently, at lower cost, for brands that no longer have the extended periods of high-priced market exclusivity that once justified a major Hub investment.
Expect some tough conversations around what can be automated to lower those costs, and what still requires that full suite of “high touch” services. Notes Reinhardt, “just hitting a button in real time sounds great, but the reality is the U.S. health system is not yet ready for digital convergence.” Helping clients identify where automation will work—and where it won’t—is going to be a big differentiator of Hub service quality in the years ahead.”
With disruptive change stamped as a more or less permanent feature of the biopharma landscape, Reinhardt concluded by telling CBI delegates that Triplefin is a safe harbor—a place to try things differently. “Our simple message to brand clients is: come to us as you are. The skill set we employ on behalf of patients is flexible on logistics and tolerant of diverse approaches to both strategy and execution. And it’s powered by deep industry knowledge, from hard data analytics to the wisdom that can only be drawn from collective human experience in the field.”
In other words, the successful patient journey takes many paths.
Published December 2016 | Reproduced with permission by Pharmaceutical Executive